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NPI Code Detail

MEDICARE: AMY W MARENICK M.ED., N.C.C., L.P.C

MEDICARE: AMY W MARENICK M.ED., N.C.C., L.P.C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor1962SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1570629234006OTHERSCBCBS

General Provider Information

NPI Number : 1407920861
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY W MARENICK M.ED., N.C.C., L.P.C
Provider Business Mailing Address
First Line : 912 GRISTMILL DR
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-9801
Country : US
Telephone Number : 803-366-8727
Fax Number : 803-328-5443
Provider Business Practice Location Address
First Line : 2400 W MAIN ST
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-8968
Country : US
Telephone Number : 803-327-6103
Fax Number : 803-328-5443
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/08/2007

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